Provider Demographics
NPI:1275379885
Name:LUSCIOUS HEART
Entity type:Organization
Organization Name:LUSCIOUS HEART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OLAJUWON
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABIJO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:951-269-8199
Mailing Address - Street 1:10722 CHERRY TREE WAY # 76065
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-7249
Mailing Address - Country:US
Mailing Address - Phone:951-269-8188
Mailing Address - Fax:
Practice Address - Street 1:10722 CHERRY TREE WAY # 76065
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-7249
Practice Address - Country:US
Practice Address - Phone:951-269-8188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care